Anesthesia and analgesia
-
Anesthesia and analgesia · Jul 2010
Randomized Controlled Trial Comparative StudyDay-surgery patients anesthetized with propofol have less postoperative pain than those anesthetized with sevoflurane.
There have been recent studies suggesting that patients anesthetized with propofol have less postoperative pain compared with patients anesthetized with volatile anesthetics. ⋯ The patients anesthetized with propofol appeared to have less pain than patients anesthetized with sevoflurane.
-
Anesthesia and analgesia · Jul 2010
ReviewTransesophageal echocardiographic evaluation during aortic valve repair surgery.
For patients with aortic valve (AV) disease, the classic treatment has been AV replacement and this remains true for aortic stenosis. In contrast, repair of isolated aortic insufficiency (AI), with or without aortic root pathology, is emerging as a feasible and attractive option to replacement. ⋯ Intraoperative transesophageal echocardiographic evaluation permits analysis of the mechanisms of aortic regurgitation as well as differentiation between repairable and unrepairable AV pathology. Immediate postrepair transesophageal echocardiography provides important information about the quality and durability of repair and identifies variables associated with recurrent AI.
-
Anesthesia and analgesia · Jul 2010
ReviewResidual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block.
In this review, we summarize the clinical implications of residual neuromuscular block. Data suggest that residual neuromuscular block is a common complication in the postanesthesia care unit, with approximately 40% of patients exhibiting a train-of-four ratio <0.9. Volunteer studies have demonstrated that small degrees of residual paralysis (train-of-four ratios 0.7-0.9) are associated with impaired pharyngeal function and increased risk of aspiration, weakness of upper airway muscles and airway obstruction, attenuation of the hypoxic ventilatory response (approximately 30%), and unpleasant symptoms of muscle weakness. ⋯ Large databased investigations have identified intraoperative use of muscle relaxants and residual neuromuscular block as important risk factors in anesthetic-related morbidity and mortality. Furthermore, observational and randomized clinical trials have demonstrated that incomplete neuromuscular recovery during the early postoperative period may result in acute respiratory events (hypoxemia and airway obstruction), unpleasant symptoms of muscle weakness, longer postanesthesia care unit stays, delays in tracheal extubation, and an increased risk of postoperative pulmonary complications. These recent data suggest that residual neuromuscular block is an important patient safety issue and that neuromuscular management affects postoperative outcomes.
-
Anesthesia and analgesia · Jul 2010
Functional properties of RYR1 mutations identified in Swedish patients with malignant hyperthermia and central core disease.
A diagnosis of malignant hyperthermia susceptibility by in vitro contraction testing can often only be performed at specialized laboratories far away from where patients live. Therefore, we have designed a protocol for genetic screening of the RYR1-cDNA and for functional testing of newly identified ryanodine receptor 1 (RYR1) gene variants in B lymphocytes isolated from peripheral blood samples drawn at local primary care centers. ⋯ Peripheral blood samples are stable regarding RNA and DNA extraction and establishment of lymphoblastoid B cell lines after transportation at ambient temperature over large distances by ordinary mail. Functional tests on B cells harboring the newly identified amino acid substitutions indicate that they alter intracellular Ca2+ homeostasis and are most likely causative of malignant hyperthermia.